Jefferson County would exit health care business under proposal

BIRMINGHAM, Alabama -- Jefferson County commissioners next week will hear a proposal to take the county out of the health care business by placing Cooper Green Mercy Hospital and the county nursing home under a health care authority.

Jefferson County Commissioner George Bowman (The Birmingham News/Mark Almond)

Commissioner George Bowman said he will unveil the proposal at Tuesday's health and general services committee meeting.

"I will be asking the commission to approve the establishment of a health-care authority and to move all of Cooper Green, to include its employees and the costs, into the health-care authority," Bowman said in an interview Wednesday.

Some commissioners say they're not opposed to the idea.

"The authority would be able to raise its own money to match the indigent care fund," which is used to operate the hospital, Commissioner Sandra Little Brown said. "Plus, the county has had to fall in line to help keep Cooper Green afloat every year" with money from the general fund.

Bowman said the indigent care fund would also be transferred to the health-care authority's control.

A bill was introduced during the recent session of the Alabama Legislature to remove earmarks that direct a portion of county sales tax money to the indigent care fund. The creation of the authority could thwart those attempts in the future, Brown said.

A report earlier this year showed that Cooper Green in fiscal 2010 got $9 million from the county's general fund and $41.2 million from the indigent care fund.

Commissioner Jimmie Stephens said he would support any viable initiative that safeguards the county's ailing general fund.

"My goal is to make Cooper Green self-sufficient and to not have any stress on the general fund budget," Stephens said. "I will have an open mind as we move forward, but I don't have enough details to make a decision."

Commissioner Joe Knight said he would look forward to Tuesday's presentation.

"I'm open to whatever they would like us to consider," Knight said. "I'm certainly not closed-minded. I don't see how they would be able to do it, but I'm all ears."

Commission President David Carrington said the county home is being sold and would not come under the health care authority. As for the other two facilities, Carrington said he needed to see a "detailed business plan with the revenues and expenses."

Bowman said the commission would be responsible for appointing members to the authority, which could include between five and nine people. A transition team, advisory committee and board of directors will be discussed Tuesday.

Dr. Sandral Hullett, CEO of Cooper Green, said she supports the creation of an authority.

"My major issue has been the lack of flexibility," Hullett said. "Health care needs to be able to move at the right time. You have to be able to change things when you need the change. You don't need three months to hire somebody. .¤.¤. I see a health-care authority giving us that flexibility."

Under the plan to be discussed, Cooper Green, the Jefferson Rehabilitation and Health Center -- more commonly known as the county nursing home -- and the central laundry would come under the authority.

That would make health services more efficient, Bowman said.

"There are some economies of scale that can be achieved through purchasing where we can save money," he said. "They all buy hospital products and there are some conglomerates that provide hospital supplies, and they can buy into those entities and realize a cost savings."

Another advantage, Bowman said, would be in human resources.

"They will handle their own staffing and they can freely move folks from one organization to another that we cannot really do right now because of personnel board rules," he said. "They will all be employed under the authority and could be used to satisfy needs at Cooper Green and the rehab center."

Richard Finley, an assistant to Bowman, said the authority would help save jobs.

"If the hospital is allowed to exist in a new authority vs. closing it down, 700 to 800 local jobs will be saved," Finley said.

Some county commissioners have questioned whether the county should be in the hospital business. Others say Cooper Green needs to end its hospital services and operate solely as an outpatient clinic.

"We have often heard the commissioners say they shouldn't be in the hospital business," Hullett said. "We definitely feel that there's a need for our services. Given the opportunity to function the way most hospitals function, we could deliver those services. We won't be UAB, we can't be UAB, but we would take care of most of the basic needs of people in this community."

Bowman said he is aware some on the commission want to get out of the health-care business.

"This action protects Cooper Green, preserves the organization and the mission of Cooper Green for this community and this county," he said. "It also provides professional management for Cooper Green and the rehab center that is not contingent on who gets elected to the County Commission and their personal feelings about health care."

To take effect, the plan must garner majority support from the health and general services committee next week and then pass the full commission. Resolutions approved by the full commission are also needed to transfer to the authority all assets, hospital tax proceeds and records and to give the hospital autonomy to manage all operations, resources and other support currently performed or supplied by the county.

Also, a decision must be made on how to calculate compensation benefits, health-care benefits and retirement plans for workers who will be employed under the authority and no longer by the county.

In 2004, the County Commission passed a resolution authorizing the Jefferson Metropolitan Health Care Authority to oversee all county health operations and assets, including Cooper Green, and to provide health care for the county jails in Birmingham and Bessemer. However, the group was never fully funded or functional, Bowman said.